中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

感染性心内膜炎手术危险因素分析

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目的 回顾性分析感染性心内膜炎死亡与瓣周漏的危险因素,评价感染性心内膜炎手术时机选择。 方法 回顾性分析 2015 年 8 月至 2017 年 8 月在我院行手术治疗的 62 例感染性心内膜炎病例的临床资料。其中男 43 例、女 19 例,年龄 19~75(46.1±16.6)岁。将临床资料分为死亡组与存活组,瓣周漏组与无瓣周漏组,急诊手术组和非急诊手术组,探讨感染性心内膜炎手术危险因素及手术时机的选择。 结果 62 例术后患者,早期死亡 3 例,死亡率 4.8%,其中 1 例死于肾功能衰竭,1 例死于多器官脏器衰竭,1 例死于急性左心衰。术后瓣周漏(反流束≥2 mm)患者 8 例,占总体的 12.9%。单因素分析显示术前患者白蛋白含量、肌酐水平、体外循环总时间和升主动脉阻断时间与术后早期死亡有显著意义(P<0.05)。患者年龄、术前白蛋白含量、肌酐水平、体外循环总时间、升主动脉阻断时间与术后早期瓣周漏的发生有显著意义(P<0.05)。多因素 logistic 回归模型分析表明升主动脉阻断时间长是感染性心内膜炎患者术后早期死亡的独立危险因素(P<0.05)。多因素 logistic 回归模型分析表明白蛋白低,年龄大是感染性心内膜炎患者术后早期瓣周漏的独立危险因素(P<0.05)。卡方检验提示急诊手术与非急诊手术在早期死亡和瓣周漏的发生上无显著差异。 结论 感染性心内膜炎患者排除禁忌证后应早期手术治疗,手术方式的选择应根据患者实际情况分析选择,术前应注意患者白蛋白及肌酐水平,术中尽量缩短体外循环时间时间及升主动脉阻断时间有助于改善患者预后。

Objective To analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. Methods We retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75 (46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a non-emergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed. Results Three of the 62 patients (4.8%) died after surgery. Postoperative perivalvular leakage (regurgitation over 2 mm) in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality (P<0.05). Age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage (P<0.05). The chi square test suggested that there was no significant difference between the early death and the perivalve leakage in the emergency operation and the non emergency operation. Conclusion Patients with infective endocarditis should accept early surgical treatment.The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in patients with preoperative. In the operation, to shorten extracorporeal circulation time and aortic clamping time can improve the prognosis of patients.

关键词: 感染性心内膜炎; 危险因素; 手术时机

Key words: Infective endocarditis; risk factors; time of operation

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